Aging has shown to have various effects on individuals, in terms of cardiovascular, neuromuscular, musculoskeletal, and other systems. Muscle strength is important for daily activities, mobility, balance, and other components of function. Various research has shown that the aging process generally leads to a decline in strength.(1) A loss in muscle mass, muscle fibers, and nerve fibers can lead to this reduction as well as impairments in power and function observed in older adults.(2,3) Sarcopenia, or loss of muscle mass and function, occurs with aging, and often accelerates with older age.(4) Considering the importance that muscle strength plays in being able to maintain one’s independence and activity levels as he/she ages, we need to look at activities that help maintain or regain strength in order to improve function.(5) Many studies have been performed to determine the effects of strength or resistance training, “…exercise that increases muscle strength and endurance with weights or resistance bands…” on older adults.(4) Results of these studies have led to strength training being considered a primary treatment of or prevention for sarcopenia or loss of muscle mass and strength.(4) The purpose of this topic is to show that by incorporating strength/resistance training into the older adults activity regimen, we can have a positive affect on muscle morphology/architecture, strength, balance, gait, function, overall health, and mortality rates. The objectives are for you to understand the benefits of resistance training, understand the range within guidelines for resistance training and activity, and understand the importance of including strength training into an older adults activity regimen.
Loss of strength seen in older adults has been thought to be related to loss in actual muscle-mass during the aging process.(3) Scanlon, et al. assessed morphological and architectural changes, along with strength changes in older adults following a 6-week progressive resistance training (PRT) program. Resistance training was individualized, consisting of 6-10 submaximal intensity exercises of all major muscle groups. Testing was performed to determine changes in knee extensor strength, muscle quality, and echo intensity (“based upon intramuscular connective tissue and adipose tissue relative to lean muscle mass”).(3) The study found that significant improvements occurred in the PRT group (over the control non-exercise group). Resistance training showed an increase in muscle strength, muscle quality, and in strength relative to echo intensity. Overall, the study points to a short-term resistance training program leading to significant changes in muscle architecture and morphology, along with strength.(3)
We would expect resistance training in any adult to increase overall strength. This does not change as we age, leading to the importance of prescribing strength training to older adults in order to maintain or make gains in strength levels. Mangione, et al. through a Cochrane Review, determined that the use of PRT was beneficial for increasing many components of physical fitness, including strength.(6) They reviewed 121 trials implementing PRT at high intensity levels, mostly including elastic tubing/bands, at a 2-3 times/week frequency, ranging from 8-12 weeks total. They determined that strength showed significant improvement following resistance training for all older adults over their controlled counterparts; however, an increased effect of change was observed in those performing higher intensity exercises versus low to moderate intensity.(6) Also, while those who were previously healthy older adults had an increased effect of change over those with specific health problems, both showed improvement over control groups.(6) In addition, Seco, et al. showed that strength not only improved following a combined 36 week physical activity program, including strength, but maintained some improvement following a 12 week detraining period.(1) Upper extremity (UE) strength, important for functional activities and coordinated tasks, showed some strength improvements following resistance training, in a literature review analysis.(5) However, the results do not provide many details and often UE strength was assessed but not the primary focus of the study, pointing to an area lacking in research and data.
In addition to strength gains, resistance training has shown benefits in balance, gait, and daily functional abilities. Takshashila, et al. showed improvements in Berg Balance Scores and Senior Fitness Test scores, (with significance observed in combined group measures) following a 10-week intervention of resistance training 3 times/week.(2) Components of function, including performance of activities of daily living (ADLs), gait speed, and the ability to rise out of a chair also showed significant improvements following the various resistance training periods.(2) In the previously mentioned study by Seco, et al., balance and cardiovascular fitness (increase in heart rate response to exercise) was also assessed and showed improvements that not only occurred following the combined physical activity training period, but were maintained following the detraining period.(1) Flexibility showed improvement in women, but not in men, with maintenance of these improvements evident following the detraining period.(1) Gait speed and the 6-minute Walk Test showed improved scores following the various resistance training programs implemented in trials reviewed by Mangione, et al.(6) The amount of change met or exceeded those considered to be a meaningful change value for these specific parameters. While all older adults within the resistance training groups improved compared to control groups, those without functional limitations had a stronger effect of change over those with previous functional limitations.(6)
One additional component of aging that has been of concern to researchers and clinicians is overall health status and mortality rates. When considering treatment programs or physical activity implementation, it is important to focus on those that cannot only improve previously mentioned factors of function and strength, but factors of health and quality of life. Kraschnewski, et al. determined the effects of strength training on older adults over a 15 year cohort study, in order to assess health changes and any associations with mortality rates.(7) Research was performed via survey questionnaires on older adults to determine level of activity and strength training. Individuals were categorized by amount of strength training, with those at a frequency of at least 2 times per week, considered within the guidelines provided by the American College of Sports Medicine (ACSM) and American Heart Association (AHA).(7) The study found that older adults performing resistance training that met the guidelines had “…45% lower odds of all-cause mortality, 19% lower odds of death from cancer, and 41% lower odds of cardiac death."(7) When the study controlled for demographics, health behaviors, and comorbid conditions, there was a continued significant decrease in odds of “all-cause mortality” at 19%; however, cancer- and cardiac-related mortalities, while still lessened, were not significant.(7) Unfortunately, the study also showed that only 9.6% of older adults were participating in “guideline-concordant” strength activity.(7)
Overall, the research clearly indicates the effectiveness and benefits of strength/resistance training for older adults. Through performance of resistance training (especially PRT), at a frequency of at least 2-3 times per week, one can expect to see results of improved strength, function, health and decreased mortality rates in older adults. In addition, by incorporating this form of exercise into a well-balanced and combined program of physical activity, benefits can include balance, gait speed, and other elements of daily activities and function. Improvements have been seen for those who are healthy as well as those who have specific impairments and health concerns. However, with larger results being seen among those who are healthy, we can see how important strength training, as a component of physical activity, can be in terms of prevention and improved quality of life.
References
Seco J, Abecia LC, Echevarria E, Barbero I, et al. A long-term physical activity training program increases strength and flexibility, and improves balance in older adults. Rehabilitation Nursing. 38: 37-47; 2012.
Takshashila SM, Rao K, Shete D, Hande D. Effectiveness of 10 weeks of balance and strength training on dynamic balance of older adults. Revista Romana de kinetoterapie. 18(30); 2012.
Scanlon TC, Fragala MS, Stout JR, Emerson NS, et al. Muscle architecture and strength: adaptations to short-term resistance training in older adults. Muscle Nerve. 49: 584-592; 2014.
Liu CJ, Becker J, Ford S, Heine K, Scheidt E, Wison A. Effects of upper extremity progressive resistance strength training in older adults: the missing picture. Phys & Occupat Ther in Ger. 29(4): 255-269; 2011.
Mangione KK, Miller AH, Naughton IV. Cochrane Review: Improving physical function and performance with progressive resistance strength training in older adults. PT Jour (LEAP). 90(12); 2010.
Kraschnewski JL, Sciamanna CN, Poer JM, Rovniak LS, et al. Is strength training associated with mortality benefits? A 15 year cohort study of US older adults. Preventive Med. 87:121-127; 2016.
Aging has shown to have various effects on individuals, in terms of cardiovascular, neuromuscular, musculoskeletal, and other systems. Muscle strength is important for daily activities, mobility, balance, and other components of function. Various research has shown that the aging process generally leads to a decline in strength.(1) A loss in muscle mass, muscle fibers, and nerve fibers can lead to this reduction as well as impairments in power and function observed in older adults.(2,3) Sarcopenia, or loss of muscle mass and function, occurs with aging, and often accelerates with older age.(4) Considering the importance that muscle strength plays in being able to maintain one’s independence and activity levels as he/she ages, we need to look at activities that help maintain or regain strength in order to improve function.(5) Many studies have been performed to determine the effects of strength or resistance training, “…exercise that increases muscle strength and endurance with weights or resistance bands…” on older adults.(4) Results of these studies have led to strength training being considered a primary treatment of or prevention for sarcopenia or loss of muscle mass and strength.(4) The purpose of this topic is to show that by incorporating strength/resistance training into the older adults activity regimen, we can have a positive affect on muscle morphology/architecture, strength, balance, gait, function, overall health, and mortality rates. The objectives are for you to understand the benefits of resistance training, understand the range within guidelines for resistance training and activity, and understand the importance of including strength training into an older adults activity regimen.
Loss of strength seen in older adults has been thought to be related to loss in actual muscle-mass during the aging process.(3) Scanlon, et al. assessed morphological and architectural changes, along with strength changes in older adults following a 6-week progressive resistance training (PRT) program. Resistance training was individualized, consisting of 6-10 submaximal intensity exercises of all major muscle groups. Testing was performed to determine changes in knee extensor strength, muscle quality, and echo intensity (“based upon intramuscular connective tissue and adipose tissue relative to lean muscle mass”).(3) The study found that significant improvements occurred in the PRT group (over the control non-exercise group). Resistance training showed an increase in muscle strength, muscle quality, and in strength relative to echo intensity. Overall, the study points to a short-term resistance training program leading to significant changes in muscle architecture and morphology, along with strength.(3)
We would expect resistance training in any adult to increase overall strength. This does not change as we age, leading to the importance of prescribing strength training to older adults in order to maintain or make gains in strength levels. Mangione, et al. through a Cochrane Review, determined that the use of PRT was beneficial for increasing many components of physical fitness, including strength.(6) They reviewed 121 trials implementing PRT at high intensity levels, mostly including elastic tubing/bands, at a 2-3 times/week frequency, ranging from 8-12 weeks total. They determined that strength showed significant improvement following resistance training for all older adults over their controlled counterparts; however, an increased effect of change was observed in those performing higher intensity exercises versus low to moderate intensity.(6) Also, while those who were previously healthy older adults had an increased effect of change over those with specific health problems, both showed improvement over control groups.(6) In addition, Seco, et al. showed that strength not only improved following a combined 36 week physical activity program, including strength, but maintained some improvement following a 12 week detraining period.(1) Upper extremity (UE) strength, important for functional activities and coordinated tasks, showed some strength improvements following resistance training, in a literature review analysis.(5) However, the results do not provide many details and often UE strength was assessed but not the primary focus of the study, pointing to an area lacking in research and data.
In addition to strength gains, resistance training has shown benefits in balance, gait, and daily functional abilities. Takshashila, et al. showed improvements in Berg Balance Scores and Senior Fitness Test scores, (with significance observed in combined group measures) following a 10-week intervention of resistance training 3 times/week.(2) Components of function, including performance of activities of daily living (ADLs), gait speed, and the ability to rise out of a chair also showed significant improvements following the various resistance training periods.(2) In the previously mentioned study by Seco, et al., balance and cardiovascular fitness (increase in heart rate response to exercise) was also assessed and showed improvements that not only occurred following the combined physical activity training period, but were maintained following the detraining period.(1) Flexibility showed improvement in women, but not in men, with maintenance of these improvements evident following the detraining period.(1) Gait speed and the 6-minute Walk Test showed improved scores following the various resistance training programs implemented in trials reviewed by Mangione, et al.(6) The amount of change met or exceeded those considered to be a meaningful change value for these specific parameters. While all older adults within the resistance training groups improved compared to control groups, those without functional limitations had a stronger effect of change over those with previous functional limitations.(6)
One additional component of aging that has been of concern to researchers and clinicians is overall health status and mortality rates. When considering treatment programs or physical activity implementation, it is important to focus on those that cannot only improve previously mentioned factors of function and strength, but factors of health and quality of life. Kraschnewski, et al. determined the effects of strength training on older adults over a 15 year cohort study, in order to assess health changes and any associations with mortality rates.(7) Research was performed via survey questionnaires on older adults to determine level of activity and strength training. Individuals were categorized by amount of strength training, with those at a frequency of at least 2 times per week, considered within the guidelines provided by the American College of Sports Medicine (ACSM) and American Heart Association (AHA).(7) The study found that older adults performing resistance training that met the guidelines had “…45% lower odds of all-cause mortality, 19% lower odds of death from cancer, and 41% lower odds of cardiac death."(7) When the study controlled for demographics, health behaviors, and comorbid conditions, there was a continued significant decrease in odds of “all-cause mortality” at 19%; however, cancer- and cardiac-related mortalities, while still lessened, were not significant.(7) Unfortunately, the study also showed that only 9.6% of older adults were participating in “guideline-concordant” strength activity.(7)
Overall, the research clearly indicates the effectiveness and benefits of strength/resistance training for older adults. Through performance of resistance training (especially PRT), at a frequency of at least 2-3 times per week, one can expect to see results of improved strength, function, health and decreased mortality rates in older adults. In addition, by incorporating this form of exercise into a well-balanced and combined program of physical activity, benefits can include balance, gait speed, and other elements of daily activities and function. Improvements have been seen for those who are healthy as well as those who have specific impairments and health concerns. However, with larger results being seen among those who are healthy, we can see how important strength training, as a component of physical activity, can be in terms of prevention and improved quality of life.
References